Tag: high risk

Is My Fully Vaccinated Child at Risk from Your Unvaccinated Kids?

Parents who skip or delay their own child’s vaccines often seem surprised that the rest of us are so concerned about their decision.

If vaccines work, they say, why do we care if their kids aren’t vaccinated?

Vaccines are protecting our kids, so they shouldn’t be at risk, right?

“Think of camping as an analogy. If everyone at a campground properly stores their food, bears won’t be enticed to come around. If even one person leaves their food unprotected, it invites bears in to investigate all the campsites for opportunities to eat.”

How does choosing not to immunize affect the community?

Of course, the issue isn’t just the risk to our fully vaccinated kids, but also the risk to those who are too young to be vaccinated, too young to be fully vaccinated, and those who can’t be vaccinated because of true medical contraindications.

In addition to those who are intentionally unvaccinated, these others often get caught up in outbreaks of vaccine-preventable diseases.

Is My Fully Vaccinated Child at Risk from Your Unvaccinated Kids?

But there is also a risk to those who are fully vaccinated, and no, that doesn’t mean that vaccines don’t work.

It just means that they don’t work 100% of the time.

And most of us don’t think that your vaccine choice should put our kids at extra risk.

Anti-vaccine propaganda pushes some folks to make bad decisions about vaccines.
Anti-vaccine propaganda pushes some folks to make bad decisions about vaccines.

Did you hear about the one measles outbreak in 2011 that was started by someone who was fully vaccinated?

“She had documentation of receipt of MMR vaccination at 3 years and 4 years of age. There was no travel during the incubation period and no known sick contacts. However, the index patient worked at a theater frequented by tourists.”

Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

The thing about that outbreak, is that of the 222 cases that year, she was the only one known to be vaccinated. So she was almost certainly exposed to measles by someone who wasn’t vaccinated.

As someone who was fully vaccinated, is it fair that she got caught up in those outbreaks?

It is especially unfair that our kids are at extra risk for vaccine-preventable diseases because some folks make a decision to leave their kids unvaccinated and unprotected because they believe anti-vaccine misinformation like:

  • you have nothing to worry about because your child is vaccinated – again, vaccines aren’t 100% effective, so there is still some risk until a disease is finally eradicated
  • someone who is vaccinated could also get your child sick – yes, but someone who is vaccinated would be less likely to get sick than someone who is unvaccinated
  • vaccinated kids are shedding virus, making everyone sick – no, they aren’t, not even during “shedding season
  • getting vaccinated doesn’t prevent disease, it just makes it so you have fewer symptoms, but you still get others sick – in most cases, vaccines keep you from getting sick altogether – they so prevent disease in most cases, but yes, if you still got sick, you will likely have milder symptoms than if you were completely unvaccinated
  • you can’t spread a disease you don’t have – that’s true, but if you are unvaccinated and unprotected, you are at much higher risk to get these diseases and then spread them to others
  • vaccines don’t prevent diseases from spreading anyway – if you don’t get a disease because you are vaccinated, you aren’t going to spread it
  • getting vaccinated just turns you into a carrier – this is about the study in baboons, but it doesn’t mean you shouldn’t get vaccinated

What about the idea that you will just keep your unvaccinated kids home if they do catch something?

What are the chances that you could be exposed to measles during an outbreak?
What are the chances that you could be exposed to measles during an outbreak?

Looking at all of the places that the folks in the Clark County measles outbreak exposed others, it should be clear that waiting to quarantine your child if they get sick isn’t very effective.

What’s the problem?

An infant with measles during the 2014 outbreaks in the Philippines.
An infant with measles during the 2014 outbreaks in the Philippines. Photo by Jim Goodson, M.P.H.

With many diseases, you are contagious before you show symptoms. That is especially true with a disease like measles, when you may not even realize it is measles until you finally break out in a rash, after having 3 to 5 days of high fever.

That’s why it is important to vaccinate and protect your kids. When you skip or delay a vaccine, it is not just your own family that you are putting at risk.

More on Risks from Unvaccinated Kids

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

  • pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
  • healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
  • students in nursing school and medical school, etc. – anti-HBs
  • children and adults exposed in an outbreakmeasles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
  • after a needlestick injury, etc. – to confirm immunity to hepatitis B
  • babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

  • internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
  • children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
  • evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
  • people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
  • patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.
Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

  • most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
  • it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
  • a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
  • a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
  • vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
  • postvaccination titer testing is not recommended after the chicken pox vaccine
  • in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

More on Vaccine Titer Testing

Who Dies from the Flu?

While some folks still believe that the flu is a mild infection, most people understand that the flu is a very dangerous disease.

A dangerous disease that kills hundreds of children and tens of thousands of adults each year in the United States.

Who Dies from the Flu?

In addition to thinking that the flu isn’t dangerous, some folks misunderstand just who is at risk for dying from the flu.

While it is certainly true that some people at higher risk than others, including those who are very young, very old, and those with chronic medical problems, it is very important to understand that just about anyone can die when they get the flu.

Just consider the 2017-18 flu season, in which 185 children died.

As in most years, half of the kids who died of flu during the 2017-18 flu season had no underlying medical condition. Of those who did, the most common were neurologic and pulmonary conditions.
As in most years, half of the kids who died of flu during the 2017-18 flu season had no underlying medical condition. Of those who did, the most common were neurologic and pulmonary conditions.

In addition to the fact that half of the kids who died were otherwise healthy, without an underlying high risk medical condition, it is important to realize that up to 80% were unvaccinated.

That’s a good clue that flu vaccines work and that everyone should get vaccinated and protected each year.

“Influenza vaccination during the 2015-2016 influenza season prevented an estimated 5.1 million illnesses, 2.5 million medical visits, 71,000 hospitalizations, and 3,000 P&I deaths.”

Estimated Influenza Illnesses, Medical Visits, Hospitalizations, and Deaths Averted by Vaccination in the United States

Flu vaccines aren’t perfect, but even when they are less effective than we would like, they have many benefits, including reducing your risk of dying from the flu.

Who dies from the flu?

Consider that one of the first flu deaths of the season was a 29-year-old Raleigh lawyer.

And the first pediatric flu death was an unvaccinated child in Florida without any underlying medical conditions.

Anyone can die from the flu.

Get your flu vaccine now.

More on Flu Deaths

Updated February 6, 2019

Do My Kids Need the RSV Vaccine?

While I’m sure that many parents would love to get their kids vaccinated and protected against RSV, unfortunately, we don’t yet have an actual RSV vaccine.

We do have Synagis (palivaizumab) though, a monthly injection that can be given to high risk children during RSV season to help prevent them from getting RSV.

Do My Kids Need Synagis?

Synagis is not a vaccine and doesn’t stimulate your body to make antibodies,  but is instead an injection of RSV antibodies made by recombinant DNA technology. That’s why you need to get an injection each month. The antibodies don’t last much longer.

So why doesn’t everyone get Synagis if RSV can be such a deadly disease?

For one thing, there is the high cost of Synagis injections, but there is also the fact that Synagis is only approved to be given to kids who are at high risk for severe RSV infections.

“Palivizumab prophylaxis has limited effect on RSV hospitalizations on a population basis, no measurable effect on mortality, and a minimal effect on subsequent wheezing.”

AAP on Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection

And Synagis doesn’t have as a great an effect on preventing RSV infections as we would like. That’s why we need a real RSV vaccine instead.

When to start Synagis is carefully determined by the start of RSV season.
When to start Synagis is carefully determined by the start of RSV season.

So because it likely doesn’t provide that much help to kids who aren’t at very high risk for severe disease, the latest guidelines recommend that Synagis be given to:

  • pre-term infants born before 29 weeks, 0 days’ gestation and who will be younger than 12 months at the start of the RSV season
  • preterm infants with CLD of prematurity, defined as birth at <32 weeks, 0 days’ gestation and a requirement for >21% oxygen for at least 28 days after birth.
  • certain infants with hemodynamically significant heart disease during their first year of life and might include infants with cyanotic heart defects, infants with acyanotic heart disease who are receiving medication to control congestive heart failure and will require cardiac surgical procedures and infants with moderate to severe pulmonary hypertension, infants with heart lesions that were corrected by surgery, but who continue to require medications for congestive heart failure, and children under age two years who have had a cardiac transplant.
  • certain children in their second year of life if they required at least 28 days of supplemental oxygen after birth and who continue to require medical intervention (supplemental oxygen, chronic corticosteroid, or diuretic therapy)
  • certain infants in their first year of life with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the upper airways
  • certain children in their second year of life if they will be profoundly immunocompromised during RSV season

Those who qualify get up to five monthly doses, beginning in November, to help make sure they are covered through the peak of RSV season – December to May.

Whether or not your high risk child gets Synagis, you can help to reduce their risk of getting RSV by making sure they are not exposed to tobacco smoke, keep them away from crowds of people, wash hands often, and if possible, keep them out of day care.

And get them all of their other vaccines, including a flu shot once they are six months old.

What do you do if your high risk child was denied Synagis by your insurance plan? If your infant has a qualifying condition, your pediatrician should be able to help you write an appeal to your insurance company stating that getting Synagis is a medical necessity.

More on Synagis and RSV Vaccines